| Despite daily introductions of the latest advanced technologies into the intensive care unit (ICU), some of the most fundamental questions of how to provide basic care for critically ill patients remain unanswered. For example, what is the best position in which to place a patient during mechanical ventilated? Current recommemd- ations for optimum positioning of mechanically ventilated patients are based more on wealth of scientific evidence, although the guidel- ines of the Centers for Disease Control and Prevention for prevention of nosocomial bacterial pneumonia in patients receiving mechanically assisted ventilation recommend elevating the head of the bed 30° to 45° This recommendation is based on a strong theoretical rationa- le and suggestive evidence, but definitive scientific studies have not been done. Therefor, nurses did not routinely use 30° to 45° in the ICUs. In this study, first pilot study was designed to provide preliminary data for a more extensive study of the relationship to the development of VAP; Second experimental study suggest that using of higher backrest positions in patients receiving mechanical appears to be advantageous in reducing ventilator-associated pneumonia (VAR). Information about the positioning of critically ill patients would provide preliminary data to develop nursing interventions that may improve outcomes in these patients. This study includes the followingtwo parts:1. A Pilot Study of Posture Nursing in Intensive Care Unit (ICU).In this part, to determine the usual bed e1evation and backrestposition in two medica1 intensive care units and their re1ationshipto hemodynamic status and entera1 feeding. Data were col1ected inShanghai and Shandong medica1 respiratory intensive care unit for 8months. A protractor was used to measure the e1evation of the headof the bed. Hemodynamic status was defined by systo1ic, diasto1ic,and mean arteria1 b1ood pressure measurements retrieved from eachpat ient's f1ow sheet.Results: The samp1e inc1uded 417 measurements of 57 patients. Meanbackrest e1evation was 22. 7', and 77. 7% of patients were supine.Backerst position differed significant1y (F=10. 23, P<0. 05) amongnursing shifts (days, evenings, nights) but not for systo1ic (r=0. 04,P=0. 49), diasto1ic (r=0. 0l P=0. 64), or mean arteria1 b1ood pressure(r=0. 08, P=0. 78). Backrest e1evation did not differ significant1ybetween pat ients who were receiving entera1 feedings and pat ients whowere not (T=l. 04, P>0. 05) or between patients receiving intermittentversus continuous nutrition (P=0. 076).Conclusions: Use of higher leve1s of backrest e1evation (> 30" )is minimal and is not related to use of entera1 feeding or to hemo-dynamic status. The rationa1e for using 1ower backrest positions forcritica11y il1 patients may be based on convenience, the patient )s comfort, or usua1 patterns in the unit. However, the dangers ofsupine positioning and its re1ationship to aspiration and venti 1ator--associated pneumonia shou1d not be minimized.2. Experiment Study of Aspiration of Gastric Contents in PatientsReceiving Mechanica1 Ventilation: The Effect of Posture NursingIn this part, to determine if the semirecumbent position (45-degree ang1e) decreases aspiration of gastric contents to the airwaysin intubated and mechanica11y venti1ated patients. In respiratoryintensive care unit, given a randomized, two period crossover tria1.twenty patients requiring intubation and mechanica1 venti1ation.Patients were studied in the supine and semirecumbent positions ontwo separate days. After technetium (Tc) --99m su1phur co11oid 1abe1 ingof gastric contents, sequentia1 radioactive counts in endobronchia1secretions were measured at 30--minute intervals over a 5--hour period.Samp1es o...
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